Comparison of Minimal Invasive Cardiac Surgery Incisions: Periareolar Approach In the Female Patients

Durdu, Serkan; Baran, Çağdaş; Gümüş, Fatih; Deniz, Gökay; Çakıcı, Mehmet Çağlar; Özçınar, Evren; Bermede, Onat; Uçanok, Kemalettin; Akar, Ahmet

doi:10.14744/anatoljcardiol.2018.37200

Cited by 6 publications

(6 citation statements)

References 14 publications

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“…However, one of the major setbacks of this incision is its lengthy healing duration relative to the mini-incisions along with its cosmetic impact and psychological acceptance of scar [Massimo 1999]. The appreciation of body image satisfaction has become a major concern for many patients, especially female patients [Durdu 2018]. Our cohort was no different since the majority (168 patients) were of female gender.…”

Section: Discussionmentioning

confidence: 99%

Mini Sternotomy and Mini Thoracotomy for Aortic Valve Replacement: Is There a Difference?

Mourad

Jawad

2021

HSF

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Background: Minimally invasive valve replacement is increasingly accepted among surgeons and patients alike. Ministernotomy and minithoracotomy are the most used incisions in the minimally aortic valve replacement. The superiority of one incision over the other still is debatable with a few centers having the opportunity to compare them head-to-head. Methods: A retrospective analysis of 260 patients, who underwent mini AVR, with 132 patients in the ministernotomy group and 128 patients in the minithoracotomy group. Operative details, mortality, wound cosmetics, and postoperative pain were among the primary end points. Results: A predominance of female gender has been observed in both groups. The cross-clamp and total bypass times were significantly lower in MS compared with the MT approach (63.61±16.115 vs. 70.75±33.274 min, P = 0.028, and 91.90±26.365 vs. 112.24±51.634 min, P < 0.001, respectively). The minithoracotomy group had significantly shorter lengths of wounds (5.1 ± 0.6 vs. 8.48±0.344 cm, P < 0.001). The ministernotomy group had significantly lower postoperative pain scores either in the ICU, at hospital discharge, or after 30 days at the outpatient clinic, where scores compared with MT (4.46±1.23 vs. 5.23±1.12, P < 0.001, 1.6±0.84 vs. 1.83±0.72, P = 0.019, and 1.28±0.67 vs. 1.47±0.53, P = 0.012, respectively). Conclusion: Both minimally invasive incisions for AVR proved their safety and efficacy. While the ministernotomy has the advantage of less postoperative pain and pleural complications, the minithoracotomy incision has its unmatched aesthetic appeal.

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Section: Discussionmentioning

confidence: 99%

Mini Sternotomy and Mini Thoracotomy for Aortic Valve Replacement: Is There a Difference?

Mourad

Jawad

2021

HSF

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“…This led Poffo et al to publish long-term results of the technique in 2018, supporting the use of periareolar access as a routine surgical technique for the correction of several cardiac pathologies, especially in women [6]. This was followed by Durdu et al [7] highlighting the importance of the periareolar approach in women. Maruszewski et al in Poland published a pilot study about the totally thoracoscopic periareolar approach in 2019, discussing the safety and feasibility of this approach [8].…”

Section: Discussionmentioning

confidence: 99%

“…Due to its safety and applicability to correction of mitral and tricuspid valve pathology, in addition to excellent aesthetic and functional results, Poffo et al discussed in detail the patient selection, surgical technique, benefits, and drawbacks of their technique in 2018 [6]. This was followed by Durdu et al [7], who highlighted the importance of the approach in female patients. Maruszewski et al in Poland published a pilot study about the fully thoracoscopic periareolar approach in 2019, discussing the safety and feasibility of this approach [8].…”

Section: Introductionmentioning

confidence: 99%

A randomized controlled trial (PAMI trial) on our new trend periareolar minimally invasive (PAMI) technique versus inframammary approach for minimally invasive cardiac surgery

et al. 2022

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Background A minimally invasive approach has become standard for mitral valve surgery. The periareolar approach has grown in popularity regarding the cosmesis for patients. We have adopted a new modification to the periareolar approach: the periareolar minimally invasive (PAMI) technique. The objectives of the current study are to test the hypothesis that the PAMI approach is more feasible and safer than the inframammary approach in addition to identify risk factors and assess outcomes of both periareolar and inframammary approach. Methods A randomized controlled trial of 3 months compared the PAMI technique to the inframammary approach for minimally invasive cardiac surgery. Results A total of 102 patients were enrolled and randomized into two groups: 53 received minimally invasive cardiac surgery through the periareolar approach, and 49 were the control group using the inframammary approach. Using intention-to-treat analysis, the periareolar approach was superior to the inframammary approach in surgical site infection (two cases in comparison to 8 with P = 0.004), and the number needed to treat for effectiveness was 8. No early deaths occurred, 97 cases (95.1%) needed no reoperation, and 5 cases (4.9%) were reopened for bleeding. The primary endpoints compared were the duration of procedure, duration of mechanical ventilation, amount of bleeding, ICU stay, and hospital stay. We found no statistically significant differences between the groups. At 3 months, the secondary endpoints evaluated were the rate of surgical site infection, respiratory complications, groin complications, pericardial effusion, breast hematoma, and cosmoses using a Likert scale. We found no statistically significant difference between the groups, except for surgical site infection (P = 0.004) and cosmesis (P< 0.001). Conclusions The results of this PAMI trial are suggestive that the PAMI technique is most probably applicable for the right side of the heart, such as in atrial septal defect closure, tricuspid disease, and mitral valve surgery. Trial registration PAMI Trial NCT04726488 Registered January 27, 2021

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“…The periareolar approach was developed to further reduce the trauma of endoscopic MICS [ 5–8 , 24 , 25 ]. This approach, which has been used for decades in aesthetic and/or reconstructive surgery, showed low rates of complications with excellent aesthetic outcomes [ 10 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Periareolar endoscopic minimally invasive cardiac surgery: postoperative scar assessment analysis

Praet

Kofler

Akansel

et al. 2022

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES The standard approach for minimaly invasive cardiac surgery for repair of the atrioventricular valves is a right lateral minithoracotomy. In this study we report our experience with a periareolar endoscopic approach which aims at an optimal cosmetic outcome while preserving optimal clinical outcomes. METHODS ï»¿ All patients underwent periareolar endoscopic minimaly invasive cardiac surgery using high-definition three-dimensional endoscopic visualization without additional rib-spreading. Patients presented with degenerative and/or functional mitral regurgitation. Patients undergoing concomitant tricuspid valve surgery, cryo-ablation, patent foramen ovale closure, left atrial appendage occlusion and/or left atrial myxoma extirpation were included. This descriptive paper analyzed the aesthetic and functional outcome of the periareolar scar using five most common and clinimetrically sound scar assessment scales. For statistical analysis of the scar assessment grading scales, box and whisker plots were calculated depicting median, interquartile range and high and low range data points. RESULTS Median scar assessment scale scores for n = 100 male patients (response-rate 100/109; 91.7%) were 2 [1, 4], 7.5 [6, 9], 11 [8, 14], 3 [2, 3], 10 [9, 11] for the Vancouver Scar Scale, Manchester Scar Scale, Patient Scar Assessment Scale, Stony Brook Scar Evaluation Scale, and Dermatology Quality of Life Index scales, respectively. 97 patients received mitral valve repair, 7 mitral valve replacement, whereas 5 had left atrial myxoma extirpation. Concomitant tricuspid annuloplasty, cryo-ablation, left atrial appendage occlusion and patent foramen ovale closure surgery were performed in 12, 29, 5 and 8 patients, respectively. Median procedure-, cardiopulmonary bypass-, and cross-clamp times were 169.5 [154.3, 189.3], 111.5 [97, 127], and 68.5 [58.8, 81] min, respectively. CONCLUSIONS Periareolar endoscopic minimaly invasive cardiac surgery is safe and cosmetically appealing. It is feasible and allows for complex mitral valve repair, mitral valve replacement and concomitant surgery. Data from five scar assessment scales suggest that this technique delivers patient-satisfying results regarding functional and cosmetic outcome.

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Comparison of Minimal Invasive Cardiac Surgery Incisions: Periareolar Approach In the Female Patients

Cited by 6 publications

References 14 publications

Mini Sternotomy and Mini Thoracotomy for Aortic Valve Replacement: Is There a Difference?

Mini Sternotomy and Mini Thoracotomy for Aortic Valve Replacement: Is There a Difference?

A randomized controlled trial (PAMI trial) on our new trend periareolar minimally invasive (PAMI) technique versus inframammary approach for minimally invasive cardiac surgery

Periareolar endoscopic minimally invasive cardiac surgery: postoperative scar assessment analysis

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